<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html xmlns="http://www.w3.org/1999/xhtml"
      xmlns:h="http://java.sun.com/jsf/html"
      xmlns:f="http://java.sun.com/jsf/core"
      xmlns:c="http://java.sun.com/jsp/jstl/core">
    <f:view>
        <head>
            <meta http-equiv="Content-Type" content="text/html; charset=UTF-8"/>
            <title>Facturaci&oacute;n</title>
            <link type="text/css" href="../common/css/redmond/jquery-ui-1.8.23.custom.css" rel="stylesheet" />
            <link type="text/css" href="../common/css/administrar.css" rel="stylesheet" />
            <link type="text/css" href="../common/css/ui.panel.css" rel="stylesheet" />
            <link type="text/css" href="../common/css/interface-fisheye.css" rel="stylesheet" />
            <script type="text/javascript" src="../common/js/jquery-1.4.2.min.js"></script>
            <script type="text/javascript" src="../common/js/jquery.ui.all.js"></script>
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            <script type="text/javascript" src="../common/js/messages_es.js"></script>
            <script type="text/javascript" src="../common/js/ui.panel.js"></script>
            <script type="text/javascript" src="../common/js/jquery.qtip-1.0.0-rc3.js"></script>        
            <script type="text/javascript" src="../common/js/interface.js"></script>
            <script type="text/javascript" src="../common/js/jquery.timeentry.js"></script>
            <script type="text/javascript" src="../common/js/jquery.pagination.js"></script>
            <script type="text/javascript" src="../common/js/jquery.contextMenu.js"></script>
            <link type="text/css" href="../common/css/jquery.contextMenu.css" rel="stylesheet" />
            <link type="text/css" href="../common/css/pagination.css" rel="stylesheet" />
            <script type="text/javascript" src="../common/js/jquery.qtip-1.0.0-rc3.js"></script>
            <link type="text/css" href="../common/css/jquery.timeentry.css" rel="stylesheet" />


            <script type="text/javascript">
	
                $(document).ready(
                function()
                {
                    $('#fisheye').Fisheye(
                    {
                        maxWidth: 120,
                        items: 'a',
                        itemsText: 'span',
                        container: '.fisheyeContainter',
                        itemWidth: 100,
                        proximity: 120,
                        halign : 'center'
                    }
                )
			
                }
            );

            </script>


            <style>
                #tab_estancia { height: 450px; }
                .tabs-top { position: relative; }
                .tabs-top .ui-tabs-panel { height: 250px; overflow: auto; }
                .tabs-top .ui-tabs-nav { position: absolute !important; left: 0; bottom: 0; right:0; padding: 0 0.2em 0.2em 0; }
                .tabs-top .ui-tabs-nav li { margin-top: -2px !important; margin-bottom: 1px !important; border-top: none; border-bottom-width: 1px; }
                .ui-tabs-selected { margin-top: -3px !important; }
            </style>



        </head>
        <body>                                   


            <div id="jsf">
                <h:outputText id="login" value="#{loginBean.nombreUsuario}"></h:outputText>
                <h:form id="form_oc" style="display: none">
                    <h:inputText id="idUsuario" value="#{loginBean.usuarioActivo}"></h:inputText>>
                </h:form>
            </div>


            <div id="fisheye" class="fisheye">
                <center>
                    <h1 style="color: gray">Facturaci&oacute;n de Servicios</h1>
                </center>

                <br />
                <div class="fisheyeContainter">
                    <a href="#" id="consulta_externa" class="fisheyeItem"><img src="../common/img/consulta_externa.png" width="50"/><span>Consulta Externa</span></a>
                    <a href="#" id="ambulatoria" class="fisheyeItem"><img src="../common/img/fisioterapia.png" width="50"/><span>Ambulatoria</span></a>			
                    <a href="#" id="pyp" class="fisheyeItem"><img src="../common/img/vacunacion.png" width="50"/><span>P y P</span></a>			
                    <a href="#" id="urgencias" class="fisheyeItem"><img src="../common/img/urgencias.png" width="50"/><span>Urgencias</span></a>			
                    <a href="#" id="hospitalizacion" class="fisheyeItem"><img src="../common/img/hospitalizacion.png" width="50"/><span>Hospitalizaci&oacute;n</span></a>                            

                </div>
            </div>

            <div style="display: none" id="pantalla-factura">


                <div style="width: 100%; text-align: center;">

                    <table width="100%">
                        <tr>
                            <td  class="ui-state-hover" align="left">    
                                Facturaci&oacute;n de servicios&nbsp;&nbsp;<b style="color:green;width: 230px" id="txt-servicio"></b>
                            </td>
                            <td class="ui-state-hover" align="right">
                                <button id="configBtn">Config</button>               
                            </td>
                            <td class="ui-state-hover" align="right">                            
                                <button id="ayudaBtn">Ayuda</button>               
                            </td>
                        </tr>
                    </table>          
                    <div class="tooltips"></div> 


                    <form id="form-factura">
                        
                        <div id="panel1">

                            <h3> 
                                Datos del paciente
                            </h3>   


                            <table width="100%" cellpadding="0" cellspacing="0">

                                <tr>                            

                                    <td>
                                        Fecha
                                    </td>

                                    <td>
                                        Identificaci&oacute;n
                                    </td>

                                    <td>
                                        Nombre Completo
                                    </td>

                                    <td>
                                        Edad
                                    </td>

                                    <td>
                                        Sexo 
                                    </td>    

                                    <td>
                                        Regimen
                                    </td>

                                    <td>
                                        Nivel
                                    </td>

                                    <td>
                                        T. Afiliaci&oacute;n
                                    </td>                                                                       

                                    <td style="display: none">
                                        Tipo Poblac&oacute;on
                                    </td>

                                    <td style="display: none">
                                        Tipo Paciente
                                    </td>  

                                    <td style="display: none">
                                        Fecha Nacimiento
                                    </td>

                                </tr>   
                                
                               

                                <tr> 
                                    <td>
                                        <input type="text" size="7" id="fecfac" name="fecfac" value="" />    
                                    </td>  

                                    <td>
                                        <table>
                                            <tr>

                                                <td>
                                                    <input type="text" size="14" ondblclick="buscarPacienteCodigo()" maxlength="20" id="identificacion" name="identificacion" value=""/>
                                                    <input type="hidden" id="idpaciente" name="idpaciente" value="" />
                                                    <input type="hidden" id="idmanual" value="" />

                                                    <!--se sobreescribe con idcps-->
                                                    <input type="hidden" id="idcontrato" value="" />
                                                </td>

                                                <!--<td>
                                                    <select style="width: 120px" readonly ="true"  id="id_tipo_ide" name="id_tipo_ide" class="ui-widget-content"></select>
                                                </td>-->

                                                <td>                                        
                                                    <img src="../common/img/user_search.png"  onclick="buscarPacienteCodigo()" style="cursor: pointer" alt="buscarPaciente" />                                                    
                                                </td>

                                                <!--<td>
                                                    <img src="../common/img/edit-clear.png" onclick="clearPacientecodigo()" style="cursor: pointer" alt="Eliminar" /> 
                                                </td>-->
                                            </tr>
                                        </table>
                                    </td>


                                    <td>
                                        <input type="text" size="40" readonly="true" id="nombres" value="" />

                                    </td>

                                    <td>
                                        <input type="text" size="1" readonly="true" id="edad" value=""/>

                                    </td>


                                    <td>
                                        <input type="text" size="1" readonly="true" id="sexo" value=""/>

                                    </td>
                                    <td>
                                        <input type="text" size="12" readonly="true" id="regimen" value=""/>

                                    </td>

                                    <td>
                                        <input type="text" size="1" readonly="true" id="nivel" value=""/>

                                    </td>

                                    <td>
                                        <input type="text" size="8" readonly="true" id="tipoafiliado" value=""/>

                                    </td>

                                    <td style="display: none">
                                        <input type="text" size="1" readonly="true" id="tipoPoblacion" value=""/>

                                    </td>

                                    <td style="display: none">
                                        <input type="text" size="1" readonly="true" id="tipoPaciente" value=""/>
                                    </td>

                                    <td style="display: none">
                                        <input type="text" size="10" readonly="true" maxlength="20" id="fecnac" value=""/>

                                    </td>

                                </tr>
                                
                                 <tr>
                                    

                                    <td colspan="2">
                                        Administradora
                                    </td>

                                    <td>
                                        Contratos Disponibles
                                    </td>

                                     <td colspan="5">
                                        Tarifario
                                    </td> 
                                  
                                    
                                    
                                    
                                </tr>
                                
                                <tr>
                                  
                                    <td  style="display: none">
                                        <table>
                                            <tr>
                                                <td>                                          
                                                    <input type="hidden" readonly="true" id="idservicio" value=""/>
                                                </td>                                           
                                                <td>
                                                    <input type="hidden" id="copagoserv" value=""/>
                                                </td>
                                            </tr>
                                        </table>
                                    </td>

                                    
                                    
                                    <td colspan="2" >
                                        <select style="width: 265px" id="identidad" name="identidad" class="text ui-widget-content"></select>
                                    </td>

                                    <td>
                                        <select style="width: 349px" id="idcps" name="idcps" class="text ui-widget-content"></select>
                                    </td>

                                    <td colspan="5">
                                        <input type="text" size="42" readonly="true" id="tarifario" value=""/>
                                    </td>         

                                    <td>
                                        <table>
                                            <tr>

                                                <td>
                                                    <!--
                                                    <img src="../common/img/medico.png" onclick="buscadorMedicos()" style="cursor: pointer" />
                                                    <img src="../common/img/edit-clear.png" onclick="clearMedico()" style="cursor: pointer" alt="Eliminar" />
                                                    -->
                                                    <!--<input type="hidden" id="idmedico" value=""/>-->
                                                </td>
                                            </tr>
                                        </table>
                                    </td>


                                    
                                    
                                </tr>
                            </table>
                        </div>


                        <!--<div id="panel2">
                            <h3>Atenci&oacute;n</h3>
                            <table width="100%" cellpadding="0" cellspacing="0">                     
                                
                                <tr>

                                    <td colspan="2">
                                        Administradora
                                    </td>

                                    <td>
                                        Contratos Disponibles
                                    </td>

                                    <td>
                                        Tarifario
                                    </td> 
                                </tr>
                                <tr>
                                    <td  style="display: none">
                                        <table>
                                            <tr>
                                                <td>                                          
                                                    <input type="hidden" readonly="true" id="idservicio" value=""/>
                                                </td>                                           
                                                <td>
                                                    <input type="hidden" id="copagoserv" value=""/>
                                                </td>
                                            </tr>
                                        </table>
                                    </td>

                                    <td colspan="2" >
                                        <select style="width: 265px" id="identidad" name="identidad" class="text ui-widget-content"></select>
                                    </td>

                                    <td>
                                        <select style="width: 349px" id="idcps" name="idcps" class="text ui-widget-content"></select>
                                    </td>

                                    <td>
                                        <input type="text" size="42" readonly="true" id="tarifario" value=""/>
                                    </td>         

                                    <td>
                                        <table>
                                            <tr>

                                                <td>
                                                    
                                                    <img src="../common/img/medico.png" onclick="buscadorMedicos()" style="cursor: pointer" />
                                                    <img src="../common/img/edit-clear.png" onclick="clearMedico()" style="cursor: pointer" alt="Eliminar" />
                                                    
                                                    <input type="hidden" id="idmedico" value=""/>
                                                </td>
                                            </tr>
                                        </table>
                                    </td>


                                </tr>

                            </table>

                        </div>-->


                        <div id="panel3">
                            <h4>Servicios (APIs)</h4>

                            <table width="100%" cellpadding="0" cellspacing="0">

                                <tr>
                                    <td>
                                        C&oacute;digo
                                    </td>
                                    <td colspan="2">
                                        Descripci&oacute;n
                                    </td>
                                    <td>
                                        Cant
                                    </td>
                                    <td>
                                        Valor
                                    </td>

                                    <td>
                                        M&eacute;dico Atiende
                                    </td>

                                </tr>
                                <tr>
                                    <td>

                                        <table>
                                            <tr>
                                                <td>
                                                    <!--<input type="text" size="10" onblur="buscarActividadCodigo()" maxlength="20" id="codact" value=""/>-->  
                                                    <!-- <input type="text" size="10" ondblclick="/*buscarActividadCodigo()*/" maxlength="20" id="codact" value=""/>-->
                                                    <input type="text" size="10" ondblclick="buscarActividadCodigo()" maxlength="20" id="codact" value=""/>


                                                </td>
                                                <td>
                                                    <img src="../common/img/case.png" onclick="buscarActividadCodigo()" style="cursor: pointer" styleClass="icon" />
                                                    <!--<img src="../common/img/edit-clear.png" onclick="clearActividadcodigo()" style="cursor: pointer" styleClass="icon" alt="Eliminar" />-->
                                                    <input type="hidden" id="idact" name="idact" value=""/>
                                                    <input type="hidden" id="grupoact" value=""/>
                                                    <input type="hidden" id="tiporegact" name="tiporegact" value=""/>

                                                </td>
                                            </tr>
                                        </table>
                                    </td>
                                    <td colspan="2">
                                        <input type="text" size="50" readonly="true" id="desact" value=""/>

                                    </td>
                                    <td>
                                        <input type="text" size="1"  id="cant" value="1"/>

                                    </td>

                                    <td>
                                        <input type="text" size="6" readonly="true" id="valor" value=""/>

                                    </td>

                                    <td>
                                        <!--
                                        <input type="text" ondblclick="buscadorMedicos()" readonly="true" size="40" maxlength="40" id="medico" value=""/>
                                        -->
                                        <select style="width: 255px" id="idmedico" name="idmedico" class="text ui-widget-content"></select>
                                    </td>

                                    <!--<td>
                                        <button id="btnAgreAct" onclick="agregarActividadIndividual()" class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only">
                                            <img src="../common/img/carrito.png" style="cursor: pointer"/>
                                        </button>
                                    </td>-->




                                    <!--<td>

                                        <button id="btnAgreAct" onclick="agregarActividad()" class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only">
                                            <img src="../common/img/addapi.png" style="cursor: pointer" />
                                        </button>



                                    </td>-->

                                </tr>
                            </table>
                        </div>
                    </form>


                    <div id="camposOcultosValidacion" style="display: none">

                        <input type="hidden" id="idadmision" value="0"/>
                        <input type="hidden" id="iddetalleadmision" value="0"/>
                        <input type="hidden" id="espyp" value="0"/>
                        <input type="hidden" id="idplaneacionpyp" value="0"/>
                        <input type="hidden" id="idCita" value="0"/>
                    </div>



                    <center>
                        <button id="btnAgreAct" onclick="agregarActividadIndividual()" class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only">
                            <img src="../common/img/addapi.png" style="cursor: pointer" />
                        </button>


                    </center>

                    <div id="panel4">
                        <h4>Servicios Seleccionados</h4>
                        <div>
                            <table id="res" class='ui-widget-content' width="100%">
                                <tr class="ui-state-default">
                                    <th style="display: none" width="25px">No.</th>
                                    <th width="50px">C&oacute;digo</th>
                                    <th width="600px">Descripci&oacute;n</th>
                                    <th width="25px">Cant</th>
                                    <th width="100px">V. Total</th>
                                    <th width="100px">V. Entidad</th>
                                    <th width="100px">V. Paciente</th>
                                    <th>Eliminar</th>
                                </tr>
                            </table>
                        </div>

                    </div>


                    <div id="panel5">

                        <table align="right" border="1">
                            <tr>
                                <td>Total Factura</td>
                                <td align="right" width="93px">
                                    <input type="text" id="total" value="0" size="10" readonly="true"/>
                                </td>
                                <td>Total Entidad</td>
                                <td align="right" width="93px">
                                    <input type="text" id="totpaciente" value="0" size="10" readonly="true"/>
                                </td>
                                <td>Total Paciente</td>
                                <td align="right" width="93px">
                                    <input type="text" id="totentidad" value="0" size="10" readonly="true"/>
                                </td>

                                <td id="lblcontratopyp" style="display: none">
                                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                                    &nbsp;&nbsp;
                                    Programa PYP
                                </td>
                                <td class="ui-widget-content" id="programa"  style="display: none">
                                </td>

                            </tr>
                        </table>

                    </div>




                </div>

                <center>
                    <!---->

                    <button id="grabarBtn" onclick="abrirdialogoRips()"> Grabar</button>
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;



                    <!--<button id="liquidarBtn" onclick="abrirdialogoRips()"> Liquidar</button>
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;-->


                    <!-- esperar para liquidar la factura, despues de los descuentos realizados.-->
                    <button id="liquidarBtn" onclick="enviarDatosBd()"> Liquidar</button>
                    &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;

                    <button id="cancelarBtn" onclick="cancelarFactura()"> Cancelar</button>  

                </center>


            </div>


            <!--BUSCADORES-->

            <!--Buscar Actividades-->
            <div id="dialogoBuscar" style="display: none" title="ACTIVIDADES">
                <br />
                <div id="busquedaDiv">
                    <table width="100%">
                        <tr class="ui-widget-header">
                            <td>C&oacute;digo</td>
                            <td>
                                <input type="text" onkeyup="this.value=this.value.toUpperCase()" id="codigoBusq" size="16" maxlength="16"/>
                            </td>
                            <td>Descripci&oacute;n</td>
                            <td>
                                <input type="text" onkeyup="this.value=this.value.toUpperCase()" id="descBusq" size="45" maxlength="45"/>
                            </td>
                        </tr>
                        <tr>
                            <td colspan="4" align="center">
                                <input class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only"  id="buscar" type="button" value="Buscar"/>
                            </td>
                        </tr>
                    </table>
                </div>
                <div id="datos" style="display: none">
                </div>

            </div>

            <!--Buscar Pacientes-->
            <div id="dialogoBuscarPac" style="display: none" title="PACIENTES">


                <div id="busquedaDivPac">
                    <table width="100%">
                        <tr class="ui-widget-header">
                            <td>
                                Identificaci&oacute;n
                            </td>
                            <td>&nbsp;</td>
                            <td>&nbsp;</td>
                            <td>&nbsp;</td>
                        </tr>
                        <tr class="ui-widget-header">                    
                            <td>
                                <input onkeyup="validarBusquedaPac(1)" type="text" id="ide" size="16" maxlength="16"/>
                            </td>
                            <td>&nbsp;</td>
                            <td>&nbsp;</td>
                            <td>&nbsp;</td>
                        </tr>

                        <tr class="ui-widget-header">

                            <td>Primer Nombre</td>
                            <td>Segundo Nombre</td>
                            <td>Primer Apellido</td>
                            <td>Segundo Apellido</td>
                        </tr>
                        <tr>                    
                            <td>
                                <input onkeyup="this.value=this.value.toUpperCase();validarBusquedaPac(2)" type="text" id="n1" size="15" maxlength="20"/>
                            </td>
                            <td>
                                <input onkeyup="this.value=this.value.toUpperCase();validarBusquedaPac(2)" type="text" id="n2" size="15" maxlength="20"/>
                            </td>
                            <td>
                                <input onkeyup="this.value=this.value.toUpperCase();validarBusquedaPac(2)" type="text" id="a1" size="15" maxlength="20"/>
                            </td>
                            <td>
                                <input onkeyup="this.value=this.value.toUpperCase();validarBusquedaPac(2)" type="text" id="a2" size="15" maxlength="20"/>
                            </td>
                        </tr>
                        <tr>
                            <td colspan="5" align="center">
                                <input class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only" id="buscarPac" type="button" value="Buscar"/>
                            </td>
                        </tr>

                    </table>
                </div>
                <div id="datosPac" style="display: none">
                </div>

            </div>


            <div id="acttemp" style="display: none">
                <input type="text" id="vrempresatmp" value="0"/>
                <input type="text" id="vrpacientetmp" value="0"/>  
                <input type="text" id="idusuario" value="1"/>
                <input type="text" id="idprestador" value="1"/>
            </div>


            <!--Buscar Servicio Ubicacion-->
            <div id="dialogoBuscarServ" style="display: none" title="SERVICIOS">


                <br />
                <div id="busquedaDivServ">
                    <table>
                        <tr>
                            <td>C&oacute;digo</td>
                            <td>
                                <input type="text" id="codigoBusqServ" size="2" maxlength="2"/>
                            </td>
                            <td>Descripci&oacute;n</td>
                            <td>
                                <input type="text" id="descBusqServ" size="25" maxlength="25"/>
                            </td>
                        </tr>
                    </table>
                </div>
                <div id="datosServ" style="display: none">
                </div>
            </div>

            <!--ACTIVIDADES DE CONSULTA-->
            <div id="dialogoBuscarConsulta" style="display: none" title="CONSULTAS">        
                <select style="width: 230px" id="idconsulta" name="idconsulta" class="text ui-widget-content"></select>
            </div>


            <!--Buscar Servicio Medico-->
            <div id="dialogoBuscarMed" style="display: none" title="MEDICOS">

                <div id="busquedaDivMed">
                    <table>
                        <tr>
                            <td>Identificaci&oacute;n</td>
                            <td>Nombre</td>
                        </tr>
                        <tr>
                            <td>
                                <input type="text" id="codigoBusqMed" size="20" maxlength="20"/>
                            </td>

                            <td>
                                <input type="text" id="descBusqMed" size="50" maxlength="50"/>
                            </td>
                        </tr>
                    </table>
                </div>
                <div id="datosMed" style="display: none">
                </div>
            </div>


            <!--dialogo liquidacion de factura-->
            <div id="dialogoLiquidarFactura" style="display: none" title="LIQUIDACION DE FACTURA">
            </div>

            <!--dialogo rips-->
            <div id="dialogoRips" style="display: none" title="RIPS">
            </div>

            <!--dialogo confirmar rips-->
            <div id="dialogoConfirmaRips" style="display: none" title="Informacion">
                Desea ingresar el rips para la factura?
            </div>

            <!--dialogo confirmar CAJA-->
            <div id="dialogoConfirmaImpresion" style="display: none" title="Informacion">     
            </div> 

            <div id="citas-form" title="Info" style="display: none"></div>

            <!--DIALOGO CONFIGURACION-->
            <div id="dialogoConfiguracion" title="Configuracion" style="display: none">
            </div>


            <!--ACTIVIDADES DE LA ADMISION-->
            <div id="dialogoActividadesCargadasAdmision" style="display: none" title="ACTIVIDADES DE LA ADMISION">        
                <select style="width: 230px" id="idactix" name="idactix" class="text ui-widget-content"></select>
            </div>

            <!--dialogo admision-->
            <div id="dialogoAdmision" style="display: none" title="Admision">              

                    <div id="panel-00">
                     <form id="frm-adm-pac">


                        <h3 class="ui-widget-header"> 
                            Datos del paciente
                        </h3>   



                        <table width="100%" cellpadding="0" >
                            <tr class="ui-widget-header">                                    

                                <td>
                                    Fecha
                                </td>

                                <td>
                                    Identificaci&oacute;n
                                </td>

                                <td>
                                    Nombre Completo
                                </td>

                                <td>
                                    Edad
                                </td>

                                <td>
                                    Sexo 
                                </td>    

                                <td>
                                    Regimen
                                </td>

                                <td style="display: none">
                                    Nivel
                                </td>
                            </tr>

                            <tr>   

                                <td>                                        
                                    <input size="12" type="text" id="fec_adm" />
                                </td>

                                <td>
                                    <input size="16" type="text" id="identificacion_adm" />
                                    <input type="hidden" id="idpaciente_adm" name="idpaciente_adm" value="" />
                                    <input type="hidden" id="idmanual_adm" value="" />

                                    <input type="hidden" id="idcontrato_adm" value="" />
                                </td>

                                <td>
                                    <input size="38" type="text" id="nombres_adm"/>
                                </td>

                                <td>                                        
                                    <input size="1" type="text" id="edad_adm" />
                                </td>

                                <td>
                                    <input size="1" type="text" id="sexo_adm" />
                                </td>
                                <td>                                        
                                    <input size="13" type="text" id="regimen_adm" />
                                </td>

                                <td style="display: none">
                                    <input size="1" type="text" id="nivel_adm" />
                                </td>
                            </tr>  

                            <tr class="ui-widget-header">  
                                <td colspan="2">
                                    Administradora
                                </td>

                                <td>
                                    Contratos Disponibles
                                </td>

                                <td colspan="4">
                                    Autorizaci&oacute;n
                                </td>

                            </tr>
                            <tr>
                                <td colspan="2">
                                    <select style="width: 255px" id="identidad_adm" name="identidad_adm" class="text ui-widget-content"></select>
                                </td>
                                <td>
                                    <select style="width: 290px" id="idcps_adm" name="idcps_adm" class="text ui-widget-content"></select>
                                </td>     

                                <td colspan="4">
                                    <input type="text" size="24" id="autorizacion_adm" value="" />
                                </td>   

                            </tr>

                            <tr class="ui-widget-header ">                            

                                <td colspan="6">
                                    Via de Ingreso
                                </td>
                            </tr>
                            <tr>
                                <td colspan="6">
                                    <select style="width: 750px" id="id_via" name="id_via" class="text ui-widget-content"></select>                          
                                </td>
                            </tr>

                            <tr class="ui-widget-header">  

                                <td colspan="6">
                                    Causa Externa
                                </td>

                            </tr>

                            <tr>

                                <td colspan="6">
                                    <select style="width: 750px" id="id_causaex_adm" name="id_causaex_adm" class="text ui-widget-content"></select>
                                </td>                            

                            </tr>


                            <tr class="ui-widget-header"> 

                                <td colspan="6">
                                    Diagn&oacute;stico
                                </td>

                            </tr>
                            <tr>
                                <td colspan="6">

                                    <input type="hidden" size="104" name="idDx_adm" id="idDx_adm" value="0" class="ui-widget-content" />
                                    <input onkeyup="lookup(this.value,17);" onblur="fill17();"  size="104" type="text" id="codDx_adm" ondblclick="this.value='';$('#idDx_adm').val('0')"/>                                                                        
                                    <div class="suggestionsBox" id="sug_dxing_adm" style="display: none;">
                                        <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                        <div class="suggestionList" id="sug_dxingList_adm">
                                            &nbsp;
                                        </div>
                                    </div>
                                </td>      


                            </tr>



                            <tr class="ui-widget-header">  

                                <td colspan="6">
                                    M&eacute;dico
                                </td>

                            </tr>                   
                            <tr>                

                                <td colspan="6">
                                    <select style="width: 750px" id="id_medico_adm" name="id_medico_adm" class="text ui-widget-content"></select>
                                </td>

                            </tr> 

                        </table>


                    
                </form>
                </div>

            </div>


            <!--DIALOGOS PARA LLENAR RIPS-->

            <!--DIALOGOS PARA LLENAR RIPS CONSULTA-->

            <div id="dialogoParaCapturarRipsConsulta" style="display: none" title="RIPS CONSULTA">

                <div id="panelParaCapturarRipsConsulta">
                    <form id="rips-cn">


                        <input type="hidden" id="iddetallecn" name="iddetallecn" value="0" />                   
                        <input type="hidden" id="valorcn" name="valorcn" value="0" />
                        <input type="hidden" id="valorcopagocn" name="valorcopagocn" value="0" />
                        <input type="hidden" id="valortotalcn" name="valortotalcn" value="0" />

                        <input type="hidden" id="band_rips" name="band_rips" value="0" />

                        <!--<input type="text" id="idfactura_ac" name="idfactura_ac"/>-->
                        <!-- <input type="hidden" id="cod_actividad" name="cod_actividad" value="0" />-->




                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>C&oacute;digo</td>
                                <td>Descripci&oacute;n</td>
                            </tr>
                            <tr>
                                <td>
                                    <input size="20" type="text" id="codactripcn" name="codactripcn" readonly="true"/>
                                </td>

                                <td>
                                    <input size="50" type="text" id="desactripcn" readonly="true"/>
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Fecha</td>
                                <td>Autorizacion</td>
                            </tr>
                            <tr>
                                <td>
                                    <input size="20" type="text" id="fecharipcn" name="fecharipcn" value="0" readonly="true"/>
                                </td>

                                <td>
                                    <input size="50" type="text" id="ordenripcn" name="ordenripcn" value="0" />
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Finalidad</td>
                                <td>Causa Externa</td>
                            </tr>
                            <tr>
                                <td>
                                    <select class="text ui-widget-content" id="finalidadcn" name="finalidadcn" value=""></select>
                                </td>

                                <td>
                                    <select class="text ui-widget-content" id="causaexcn" name="causaexcn" value=""></select>
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Diagn&oacute;stico</td>
                                <td>Tipo Diagn&oacute;stico</td>
                            </tr>
                            <tr>
                                <td>
                                    <input type="hidden" size="30" name="id_dxpalcn" id="id_dxpalcn" value="0" class="ui-widget-content" />
                                    <input onkeyup="lookup(this.value,1);" onblur="fill1();" size="50" type="text" id="dxpalcn" ondblclick="this.value='';$('#id_dxpalcn').val('')" />
                                    <div class="suggestionsBox" id="sug_dxpalcn" style="display: none;">
                                        <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                        <div class="suggestionList" id="sug_dxpalcnList">
                                            &nbsp;
                                        </div>
                                    </div>

                                </td>

                                <td>
                                    <select class="text ui-widget-content" id="tipodxcn" name="tipodxcn" value=""></select>
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Diagn&oacute;stico Relacionado 1</td>
                            </tr>
                            <tr>
                                <td>
                                    <input type="hidden" size="30" name="id_dxcn1" id="id_dxcn1" value="0" class="ui-widget-content" />
                                    <input onkeyup="lookup(this.value,2);" onblur="fill2();"  size="70" type="text" id="dxcn1"  ondblclick="this.value='';$('#id_dxcn1').val('0')"/>
                                    <div class="suggestionsBox" id="sug_dxcn1" style="display: none;">
                                        <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                        <div class="suggestionList" id="sug_dxcn1List">
                                            &nbsp;
                                        </div>
                                    </div>
                                </td>
                            </tr>
                            <tr class="ui-widget-header">
                                <td>Diagn&oacute;stico Relacionado 2</td>
                            </tr>
                            <tr>
                                <td>
                                    <input type="hidden" size="30" name="id_dxcn2" id="id_dxcn2" value="0" class="ui-widget-content" />
                                    <input onkeyup="lookup(this.value,3);" onblur="fill3();"  size="70" type="text" id="dxcn2"  ondblclick="this.value='';$('#id_dxcn2').val('0')"/>
                                    <div class="suggestionsBox" id="sug_dxcn2" style="display: none;">
                                        <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                        <div class="suggestionList" id="sug_dxcn2List">
                                            &nbsp;
                                        </div>
                                    </div>
                                </td>
                            </tr>
                            <tr class="ui-widget-header">
                                <td>Diagn&oacute;stico Relacionado 3</td>
                            </tr>
                            <tr>
                                <td>
                                    <input type="hidden" size="30" name="id_dxcn3" id="id_dxcn3" value="0" class="ui-widget-content" />
                                    <input onkeyup="lookup(this.value,4);" onblur="fill4();"  size="70" type="text" id="dxcn3"  ondblclick="this.value='';$('#id_dxcn3').val('0')"/>
                                    <div class="suggestionsBox" id="sug_dxcn3" style="display: none;">
                                        <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                        <div class="suggestionList" id="sug_dxcn3List">
                                            &nbsp;
                                        </div>
                                    </div>
                                </td>
                            </tr>
                        </table>

                    </form>
                </div><!--FIN DIALOGO RIPS CONSULTAS-->
            </div>



            <!--DIALOGO RIPS PROCEDIMIENTOS-->
            <div id="dialogoParaCapturarRipsProcedimientos" style="display: none" title="RIPS PROCEDIMIENTO">
                <form id="rips-ap">

                    <div id="panelParaCapturarRipsProcedimientos">


                        <input type="hidden" id="iddetalleap" name="iddetalleap" value="0"/>
                        <input type="hidden" id="valorap" name="valorap" value="0"/>
                        <input type="hidden" id="band_ripsap" name="band_ripsap" value="0" />

                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>C&oacute;digo</td>
                                <td>Descripci&oacute;n</td>
                            </tr>
                            <tr>
                                <td>
                                    <input size="20" type="text" id="codactripap" name="codactripap" readonly="true"/>
                                </td>

                                <td>
                                    <input size="50" type="text" id="desactripap"  readonly="true"/>
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Fecha</td>
                                <td>Autorizacion</td>
                            </tr>
                            <tr>
                                <td>
                                    <input size="20" type="text" id="fecharipap" name="fecharipap"  readonly="true"/>
                                </td>

                                <td>
                                    <input size="50" type="text" id="ordenripap" name="ordenripap" value="0" />
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Finalidad</td>
                                <td>Ambito Procedimiento</td>
                            </tr>
                            <tr>
                                <td>
                                    <select class="text ui-widget-content" id="finalidadap" name="finalidadap" value="0"></select>
                                </td>

                                <td>
                                    <select class="text ui-widget-content" id="ambitoap" name="ambitoap" value="0"></select>
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Diagn&oacute;stico</td>
                                <td>Personal Atiende</td>
                            </tr>
                            <tr>
                                <td>
                                    <input type="hidden" size="30" name="id_dxpalap" id="id_dxpalap" value="0" class="ui-widget-content" />
                                    <input onkeyup="lookup(this.value,5);" onblur="fill5();" size="50" type="text" id="dxpalap" ondblclick="this.value='';$('#id_dxpalap').val('')" />
                                    <div class="suggestionsBox" id="sug_dxpalap" style="display: none;">
                                        <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                        <div class="suggestionList" id="sug_dxpalapList">
                                            &nbsp;
                                        </div>
                                    </div>

                                </td>

                                <td>
                                    <select class="text ui-widget-content" id="personalatiendeap" name="personalatiendeap"></select>
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Diagn&oacute;stico Relacionado</td>
                            </tr>
                            <tr>
                                <td>
                                    <input type="hidden" size="30" name="id_dxap1" id="id_dxap1" value="0" class="ui-widget-content" />
                                    <input onkeyup="lookup(this.value,6);" onblur="fill6();"  size="70" type="text" id="dxap1"  ondblclick="this.value='';$('#id_dxap1').val('0')"/>
                                    <div class="suggestionsBox" id="sug_dxap1" style="display: none;">
                                        <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                        <div class="suggestionList" id="sug_dxap1List">
                                            &nbsp;
                                        </div>
                                    </div>
                                </td>
                            </tr>
                            <tr class="ui-widget-header">
                                <td>Complicaci&oacute;n</td>
                            </tr>
                            <tr>
                                <td>
                                    <input type="hidden" size="30" name="id_dxapcom" id="id_dxapcom" value="0" class="ui-widget-content" />
                                    <input onkeyup="lookup(this.value,7);" onblur="fill7();"  size="70" type="text" id="dxapcom"  ondblclick="this.value='';$('#id_dxapcom').val('0')"/>
                                    <div class="suggestionsBox" id="sug_dxapcom" style="display: none;">
                                        <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                        <div class="suggestionList" id="sug_dxapcomList">
                                            &nbsp;
                                        </div>
                                    </div>
                                </td>
                            </tr>
                            <tr class="ui-widget-header">
                                <td>Forma Acto Quirurgico</td>
                            </tr>
                            <tr>
                                <td>
                                    <select class="text ui-widget-content" id="formaqxap" name="formaqxap" value="0"></select>
                                </td>
                            </tr>
                        </table>
                    </div>
                </form>   
            </div><!--FIN DIALOGO RIPS PROCEDIMIENTOS-->



            <!--DIALOGO RIPS OTROS SERVICIOS-->
            <div id="dialogoParaCapturarRipsOtroServicio" style="display: none" title="RIPS OTROS SERVICIOS">
                <form id="rips-at">

                    <div id="panelParaCapturarRipsOtrosServicios">


                        <input type="hidden" id="iddetalleat" name="iddetalleat" value="0"/>
                        <input type="hidden" id="valorat" name="valorat" value="0"/>
                        <input type="hidden" id="band_ripsat" name="band_ripsat" value="0" />
                        <input type="hidden" id="cantidadat" name="cantidadat" value="0" />
                        <input type="hidden" id="valortotalat" name="valortotalat" value="0" />


                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>C&oacute;digo</td>
                                <td>Descripci&oacute;n</td>
                            </tr>
                            <tr>
                                <td>
                                    <input size="20" type="text" id="codactripat" name="codactripat" readonly="true"/>
                                </td>

                                <td>
                                    <input size="50" type="text" id="desactripat"  readonly="true"/>
                                </td>
                            </tr>
                        </table>
                        <table width="100%">
                            <tr class="ui-widget-header">
                                <td>Fecha</td>
                                <td>Autorizacion</td>
                            </tr>
                            <tr>
                                <td>
                                    <input size="20" type="text" id="fecharipat" name="fecharipat"  readonly="true"/>
                                </td>

                                <td>
                                    <input size="50" type="text" id="ordenripat" name="ordenripat" value="0" />
                                </td>
                            </tr>
                        </table>


                        <table width="100%">                                

                            <tr class="ui-widget-header">
                                <td>Tipo de Servicio</td>
                            </tr>
                            <tr>
                                <td>
                                    <select class="text ui-widget-content" id="tiposerat" name="tiposerat" value="0"></select>
                                </td>
                            </tr>
                        </table>
                    </div>
                </form>   
            </div><!--FIN DIALOGO RIPS OTROS SERVICIOS-->


            <!--DIALOGO RIPS RECIEN NACIDO-->

            <div id="dialogoParaCapturarRipsRecienNacido" style="display: none" title="RIPS RECIEN NACIDO">                     

                <div id="panelParaCapturarRipsRecienNacido">

                    <table >
                        <tr class="ui-widget-header">
                            <td>Nombre Completo</td>
                            <td colspan="3">
                                <input size="50" type="text" id="nomrn" name="nomrn"/>
                            </td>
                        </tr>
                        <tr class="ui-widget-header">
                            <td width="150px">Fecha Nacimiento</td>
                            <td>
                                <input size="12" type="text" id="fecrn" name="fecrn" value=""/>
                            </td>
                            <td width="150px">Hora Nacimiento</td>
                            <td>
                                <input size="10" type="text" id="horanac" name="horanac" value=""/>
                            </td>
                        </tr>

                        <tr class="ui-widget-header">
                            <td width="150px">Edad Gestacional</td>
                            <td>
                                <input type="text" size="2" id="edadges" name="edadges" value=""/>
                            </td>
                            <td width="150px">Control Prenatal</td>
                            <td>
                                <select id="controlpre" name="controlpre" class="text ui-widget-content">
                                    <option value="1">SI</option>
                                    <option value="2">NO</option>
                                </select>
                            </td>
                        </tr>

                        <tr class="ui-widget-header">
                            <td width="150px">Sexo</td>
                            <td>
                                <select id="idsexo" name="idsexo" class="text ui-widget-content">
                                    <option value="1">MASCULINO</option>
                                    <option value="2">FEMENINO</option>
                                    <option selected="true" value="3">APLICA AMBOS</option>
                                </select>
                            </td>
                            <td width="150px">Peso</td>
                            <td>
                                <input type="text" size="4" id="peso" name="peso" value=""/>
                            </td>
                        </tr>
                    </table>
                    <table>

                        <tr class="ui-widget-header">
                            <td width="150px">
                                Diagn&oacute;stico RN
                            </td>
                            <td>
                                <input type="hidden" size="30" name="id_dxnac" id="id_dxnac" value="" class="ui-widget-content" />
                                <input onkeyup="lookup(this.value,14);" onblur="fill14();"  size="50" type="text" id="dxnac" value="" />
                                <div class="suggestionsBox" id="sug_dxnac" style="display: none;">
                                    <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                    <div class="suggestionList" id="sug_dxnacList">
                                        &nbsp;
                                    </div>
                                </div>
                            </td>
                        </tr>

                        <tr class="ui-widget-header">
                            <td width="150px">
                                Diagn&oacute;stico Muerte
                            </td>
                            <td>
                                <input type="hidden" size="30" name="id_dxmu" id="id_dxmu" value="0" class="ui-widget-content" />
                                <input onkeyup="lookup(this.value,15);" onblur="fill15();"  size="50" type="text" id="dxmu" />
                                <div class="suggestionsBox" id="sug_dxmu" style="display: none;">
                                    <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                    <div class="suggestionList" id="sug_dxmuList">
                                        &nbsp;
                                    </div>
                                </div>
                            </td>
                        </tr>
                    </table>
                    <table width="">
                        <tr class="ui-widget-header">
                            <td width="150px">Fecha Muerte</td>
                            <td>
                                <input size="12" type="text" id="fecmu" name="fecmu"/>
                            </td>
                            <td width="150px">Hora Muerte</td>
                            <td>
                                <input size="10" type="text" id="horamu" name="horamu"/>
                            </td>

                        </tr>                                
                    </table>


                </div>

            </div>  <!--FIN DIALOGO RIPS RECIEN NACIDO-->

            <!--DIALOGO RIPS HOSPITALIZACION-->
            <div id="dialogoParaCapturarRipsHospitalizacion" style="display: none" title="RIPS HOSPITALIZACION">


                <div id="tab_estancia" class="tabs-bottom">
                    <ul>
                        <li><a href="#tab_estancia-1">Ingreso</a></li>
                        <li><a href="#tab_estancia-2">Salida</a></li>
                    </ul>

                    <form id="rips-ah">

                        <div id="tab_estancia-1">

                            <table width="100%">

                                <tr class="ui-widget-header">

                                    <td colspan="2">Fecha / Hora Ingreso</td> 

                                    <td>
                                        Via ingreso
                                    </td>

                                    <td>
                                        Autorizaci&oacute;n N°
                                    </td>                                    

                                </tr>

                                <tr>
                                    <td>
                                        <input size="12" type="text" id="fecingah" name="fecingah" class="ui-widget-content"/>                                        
                                    </td>

                                    <td>
                                        <input size="10" type="text" id="horingah" name="horingah" class="ui-widget-content"/>
                                    </td>

                                    <td>
                                        <select style="width: 200px" class="text ui-widget-content" id="viaingah" name="viaingah" ></select>
                                    </td>   

                                    <td>
                                        <input size="20" type="text" id="ordripingah" name="ordripingah"/>
                                    </td>                       


                                </tr>
                            </table>

                            <table width="100%">

                                <tr class="ui-widget-header">

                                    <td colspan="3">Causa Externa</td>

                                </tr>

                                <tr>
                                    <td colspan="3">
                                        <select style="width: 200px" class="text ui-widget-content" id="cauextingah" name="cauextingah" ></select>
                                    </td>                                        
                                </tr>                                        

                                <tr class="ui-widget-header">

                                    <td colspan="3">Diagn&oacute;stico Ingreso</td>

                                </tr>

                                <tr>
                                    <td colspan="3">
                                        <input type="hidden" size="30" name="id_dxingah" id="id_dxingah" value="0" class="ui-widget-content" />
                                        <input onkeyup="lookup(this.value,8);" onblur="fill8();"  size="80" type="text" id="dxingah" />
                                        <div class="suggestionsBox" id="sug_dxingah" style="display: none;">
                                            <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                            <div class="suggestionList" id="sug_dxingListah">
                                                &nbsp;
                                            </div>
                                        </div>
                                    </td>                        


                                </tr>

                                <tr class="ui-widget-header">
                                    <td>pabellon</td>
                                    <td>cuarto</td>                                        
                                    <td>Nro Cama</td>
                                </tr>

                                <tr>

                                    <td>
                                        <select style="width: 200px" class="text ui-widget-content" id="pabelloningah" name="pabelloningah" value="0"></select>
                                    </td>

                                    <td>
                                        <select style="width: 200px" class="text ui-widget-content" id="cuartoingah" name="cuartoingah" value="0"></select>
                                    </td>

                                    <td>
                                        <select style="width: 200px" class="text ui-widget-content" id="camaingah" name="camaingah" value="0"></select>
                                    </td>
                                </tr>   


                                <tr class="ui-widget-header">    
                                    <td colspan="3">Ingresado por</td> 
                                </tr>

                                <tr>
                                    <td colspan="3">
                                        <select style="width: 410px" class="text ui-widget-content" id="responsableingah" name="responsableingah" value="0"></select>
                                    </td>
                                </tr>     


                            </table>



                        </div>

                        <div id="tab_estancia-2">

                            <table>
                                <tr class="ui-widget-header">

                                    <td>Fecha / Hora Salida</td>

                                </tr>
                                <tr>
                                    <td>
                                        <input size="12" type="text" id="fecsalah" name="fecsalah" class="ui-widget-content"/>                                        
                                    </td>
                                    <td>
                                        <input size="10" type="text" id="horasalah" name="horasalah" class="ui-widget-content"/>
                                    </td>

                                </tr>
                            </table>

                            <table width="100%">
                                <tr class="ui-widget-header">                                       
                                    <td>Diagn&oacute;stico Salida</td>
                                </tr>
                                <tr>

                                    <td>
                                        <input type="hidden" size="30" name="id_dxsalah" id="id_dxsalah" value="" class="ui-widget-content" />
                                        <input onkeyup="lookup(this.value,9);" onblur="fill9();"  size="70" type="text" id="dxsalah" />
                                        <div class="suggestionsBox" id="sug_dxsalah" style="display: none;">
                                            <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                            <div class="suggestionList" id="sug_dxsalListah">
                                                &nbsp;
                                            </div>
                                        </div>
                                    </td>
                                </tr>

                                <tr class="ui-widget-header">
                                    <td>Diagn&oacute;stico Relacionado 1</td>
                                </tr>
                                <tr>
                                    <td>
                                        <input type="hidden" size="30" name="id_dxrel1ah" id="id_dxrel1ah" value="0" class="ui-widget-content" />
                                        <input onkeyup="lookup(this.value,10);" onblur="fill10();"  size="70" type="text" id="dxrel1ah" />
                                        <div class="suggestionsBox" id="sug_dxrel1ah" style="display: none;">
                                            <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                            <div class="suggestionList" id="sug_dxrel1Listah">
                                                &nbsp;
                                            </div>
                                        </div>
                                    </td>
                                </tr>

                                <tr class="ui-widget-header">
                                    <td>Diagn&oacute;stico Relacionado 2</td>
                                </tr>

                                <tr>
                                    <td>
                                        <input type="hidden" size="30" name="id_dxrel2ah" id="id_dxrel2ah" value="0" class="ui-widget-content" />
                                        <input onkeyup="lookup(this.value,11);" onblur="fill11();"  size="70" type="text" id="dxrel2ah" />
                                        <div class="suggestionsBox" id="sug_dxrel2ah" style="display: none;">
                                            <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                            <div class="suggestionList" id="sug_dxrel2Listah">
                                                &nbsp;
                                            </div>
                                        </div>
                                    </td>
                                </tr>

                                <tr class="ui-widget-header">
                                    <td>Diagn&oacute;stico Relacionado 3</td>
                                </tr>

                                <tr>
                                    <td>
                                        <input type="hidden" size="30" name="id_dxrel3ah" id="id_dxrel3ah" value="0" class="ui-widget-content" />
                                        <input onkeyup="lookup(this.value,12);" onblur="fill12();"  size="70" type="text" id="dxrel3ah" />
                                        <div class="suggestionsBox" id="sug_dxrel3ah" style="display: none;">
                                            <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                            <div class="suggestionList" id="sug_dxrel3ahListah">
                                                &nbsp;
                                            </div>
                                        </div>
                                    </td>
                                </tr>


                                <tr class="ui-widget-header">
                                    <td>Diagn&oacute;stico Complicaci&oacute;n</td>
                                </tr>

                                <tr>
                                    <td>
                                        <input type="hidden" size="30" name="id_dxcomah" id="id_dxcomah" value="0" class="ui-widget-content" />
                                        <input onkeyup="lookup(this.value,16);" onblur="fill16();"  size="70" type="text" id="dxcomah" />
                                        <div class="suggestionsBox" id="sug_dxcomah" style="display: none;">
                                            <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                            <div class="suggestionList" id="sug_dxcomahListah">
                                                &nbsp;
                                            </div>
                                        </div>
                                    </td>
                                </tr>





                                <tr class="ui-widget-header">
                                    <td>Estado Salida</td>
                                </tr>
                                <tr>

                                    <td>
                                        <select style="width: 200px" class="text ui-widget-content" id="estsalah" name="estsalah" ></select>

                                    </td>


                                </tr>


                                <tr class="ui-widget-header">
                                    <td>Causa Muerte</td>
                                </tr>
                                <tr>

                                    <td>
                                        <select style="width: 200px" class="text ui-widget-content" id="cauextmuesalah" name="cauextmuesalah" ></select>

                                    </td> 

                                </tr>


                                <tr class="ui-widget-header">
                                    <td>Diagn&oacute;stico de Muerte</td>
                                </tr>

                                <tr>
                                    <td>
                                        <input type="hidden" size="30" name="id_dxmuesalah" id="id_dxmuesalah" value="0" class="ui-widget-content" />
                                        <input onkeyup="lookup(this.value,13);" onblur="fill13();"  size="70" type="text" id="dxmuesalah" />
                                        <div class="suggestionsBox" id="sug_dxmuesalah" style="display: none;">
                                            <img src="../../../../../common/util/imag/upArrow.png" style="position: relative; top: -12px; left: 30px;" alt="upArrow" />
                                            <div class="suggestionList" id="sug_dxmuesalahListah">
                                                &nbsp;
                                            </div>
                                        </div>
                                    </td>
                                </tr>  


                            </table>



                        </div>
                    </form>



                </div> <!--FIN TABS-->  

            </div><!--FIN DIALOGO RIPS HOSPITALIZACION-->  

        </body>
    </f:view>
</html>
